Healthcare Provider Details

I. General information

NPI: 1720087190
Provider Name (Legal Business Name): CHARLOTTE ANN (CARTER) LEE LDCC, LADAC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 OPPENHEIMER DR SUITE 207
LOS ALAMOS NM
87544-2384
US

IV. Provider business mailing address

555 OPPENHEIMER DR SUITE 297
LOS ALAMOS NM
87544-2384
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-9736
  • Fax: 505-661-8088
Mailing address:
  • Phone: 505-662-9736
  • Fax: 505-661-8088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0064791
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number005706
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: